Background/Purpose: to investigate blood flow and microvascular reactivity by laser speckle perfusion imager (Perimed, Jarfalla) in consecutive patients affected by Raynaud’s phenomenon at baseline and following dynamic stimulations.

Methods: skin blood flow in the dorsum of the hand was measured at baseline and after cold test and post-occlusive hyperemia test  in 56 consecutive subjects affected by Raynaud’s phenomenon who attended the Rheumatology clinic of the university of Pisa between June 2011 and May 2012. 20 Healthy subjects (HS) were studied as controls. The protocol was approved by local ethic committee. All the subjects signed informed consent prior to the study. Statistical analysis was performed by ANOVA and logistic regression, both univariate and multivariate (SPSS). In view of the high number of comparisons inolved, Bonferroni correction was applied.

Results: Raynaud’s subjects were divided into two cathegories: 20  primary Raynaud’s phenomenon (PRP) defined according to LeRoy criteria and 36 Raynaud’s secondary to Systemic sclerosis (SSc-RP). 28 SSc patients fulfilled American college of rheumatology criteria for diagnosis of SSc (4 diffuse cutaneous subset and 24 limited cutaneous subset) and 8 were classified according to very early diagnosis criteria for SSc (VEDOSS). After cold test SSc RP had a significant reduction of blood flow (-58%) as compared to HS (-19%) (p= 0.01). Time to rescue of the basal value was significantly higher in SSc-RP (58 minutes) as compared to HS (18 minutes) and PRP (19 minutes) (p=0.002). Peak flow after ischemic test was significant reduced in SSc-RP (+237%) and in HS (+258%) as compared to PRP (+485%) (p=0.03, p=0.008). Post-ischemic AUC flow showed a significant difference between SSc-RP (+79%) and PRP (+167%) (p=0.01). Patchy pattern of flux distribution was significantly different between HS (5%),  PRP (20%), and SSc-RP (84%) (p< 0.0001). Differences between groups sorted out by univariate analysis were entered in a multivariate model to outline items that independently discriminated between groups. Peak flow after ischemic test and patchy pattern of flux distribution independently discriminated between HS and PRP and SSc-RP.Within SSc patients, a significant difference in peak flow after ischemic test (543% vs 150% p=0.002), in the post-occlusive hyperemic response  (158 vs 58 %  p=0.005) and in duration of hyperemic response after ischemic test (711 seconds vs 171 seconds p=0.02) was shown between patients with very early SSc (VEDOSS) versus patients with definite SSc. No difference in the dynamic of microcirculation was noticed between diffuse and limited disease.

Conclusion: our preliminary results indicate a clearcut alteration in the dynamic of microcirculation in SSc-RP as compared to PRP and HS. Within SSc patients, early disease seem to have a different pattern of microvascular reactivity as compared to estabilished disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/laser-speckle-contrast-imaging-may-help-in-the-differential-diagnosis-of-raynauds-phenomenon/